CHICAGO – Conventional wisdom holds that, given the option, patients prefer the convenience of less-frequent dosing of oral drugs, but just how much more money are patients with type 2 diabetes willing to pay out of pocket to change from daily to once-weekly dosing of their oral antidiabetic medications?
Not so much, apparently. Specifically, they’d be prepared to fork over amounts ranging from no more than an extra $3.64 per month to change from one pill twice daily to one pill once a day, up to $13.88 to switch from two pills once per day to one pill once a week, according to a new survey.
To reduce their pill burden from one pill per day to one per week, patients with type 2 diabetes would be willing to spend an extra $5.86 out of pocket per month, A. Brett Hauber, Ph.D., reported at the annual scientific sessions of the American Diabetes Association.
Dr. A. Brett Hauber
"Reducing the frequency of dosing has monetary value to patients. The value isn’t huge. It’s modest but real," declared Dr. Hauber, senior economist and vice president at RTI Health Solutions, a medical industry research and consulting firm based in Research Triangle Park, N.C.
RTI was hired by Merck to evaluate patient preferences for reducing the pill burden associated with oral antidiabetic agents relative to other patient priorities. To do so, Dr. Hauber and his coworkers employed a technique social scientists call a discrete-choice experiment.
They presented a large group of type 2 diabetes patients with a detailed survey involving a series of pairs of hypothetical oral antidiabetic drug profiles and had participants choose their preferred option for each pair. The profiles addressed reductions in average blood glucose, hypoglycemia risk, frequency of mild-to-moderate GI side effects, out-of-pocket cost, dosing frequency, weight change, and incremental risk of chronic heart failure.
Each of these attributes generated a relative importance score that enabled researchers to see what was most important to patients with type 2 diabetes. For example, the data indicated that patients considered a 13% reduction in the risk of GI side effects to be about as important as an absolute 2% reduction in the risk of developing heart failure, from 3% to 1%, Dr. Hauber explained.
The study population consisted of 923 patients with type 2 diabetes who were not on injectable therapy. A total of 197 were treatment-naive, while the rest were taking a single oral antidiabetic drug. Participants were recruited by Knowledge Networks, an online research company with access to a nationally representative sample of U.S. households. Knowledge Networks knows its recruits very, very well: The company tracks 4,500 variables on each of them.
The two strongest drivers of patient choice regarding oral antidiabetic therapy to emerge from the study were out-of-pocket cost and glucose control. Cost was hands down the most important factor. Assigning it a standardized relative importance rate of 10, glucose control came in at 5.3. This was followed by hypoglycemia at 3.1, GI side effects at 2.6, weight change at 2.5, heart failure risk at 2.0, and, lastly, daily dosing schedule at 0.8.
"What’s most interesting is every one of those relative importance scores is statistically significantly different from zero. What that means is every one of these attributes was important, at least to some extent, to patients. Some were more important than others, but everything we assessed influenced their choices," Dr. Hauber said.
Sixty-seven percent of patients preferred weekly drug dosing, but 33% actually favored daily dosing. Younger patients – those under age 45 years – particularly preferred weekly dosing over daily, by a margin of 78% to 22%. Patients not currently on treatment also expressed a stronger than average preference for weekly over daily dosing, by a margin of 75% to 25%.
"It is likely that, if we can offer more convenient, once-weekly dosing to younger patients and treatment-naive patients, it may be that they would be more likely to initiate therapy and potentially to adhere to therapy. But this is just my speculation based on the results that we have. We haven’t actually proven that here," Dr. Hauber observed.
The study was sponsored by Merck. The presenter is an executive at RTI Health Solutions, the research firm hired to conduct the investigation.